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General NPI Number Information
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NPI Number | 1366770547
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Entity Type | Organization
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Legal Business Name | PHILIP R THOMAS MD., LTD
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 112 KINGS HWY
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City | SUFFOLK
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State | VA
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Zip | 23432-1117
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Country | US
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Telephone | 757-255-4224
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Fax | 757-255-4124
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Provider Business Mailing Address
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Address Line | 112 KINGS HWY PO BOX 2068
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City | SUFFOLK
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State | VA
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Zip | 23432-1117
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Country | US
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Telephone | 757-255-4224
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Fax | 757-255-4124
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Authorized Official
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Title or Position | PHYSICIAN
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Name | PHILIP R THOMAS
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Credential |
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Telephone | 757-255-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 0101011438
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License Number State | VA
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